New Delhi, 10 March 2019: A few weeks ago, a study published in the Journal of Pediatric Psychology revealed the bias gender creates in the perception of pain. Another study published in The British Medical Journal found that women required three or more consultations, twice more often than men, before they were referred to a specialist. Studies have shown that on an average, it is more likely that women’s pain will be classified as psychogenic.

Women, seen as emotional, find doctors chalking their pain down to anxiety or stress, or other mental-health issues. Adding on to it, is the fact that there’s less research done on women’s health compared to men’s health: it took us years to instill the seriousness of period pain, and conditions like vulvodynia are still relatively unknown.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “When a woman complains of symptoms such as breathlessness, it is passed off, quite often by themselves, as anxiety or a panic attack. This is because traditionally, women are the ‘nurturers’ and ‘caregivers’ and so tend to put the health and well-being of their family ahead of their own needs. They form the backbone of the family, which holds the family together. Therefore, women should receive equal attention and care as do the men in their families. For instance, heart disease has generally never been thought to be a woman’s disease. However, heart disease is the number one cause of death in women. Despite this, women do not get diagnosed timely or take treatment timely.”

It is very important to spread awareness on the fact that women too are prone to serious health problems, which if diagnosed and treated at the right time can help in preventing further complications.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “Heart attacks do occur in women, even young women. It is important to remember that women are more likely to have atypical signs and symptoms, which may be the reason for the delay in calling for medical help. Women are more likely to have pain in the jaw, neck or back (between the shoulder blades), unexplained weakness, shortness of breath, cough, dizziness or nausea. We must take care of all women in our families, their health and well-being, even if they don’t do it themselves.”

Some tips from HCFI

Reduce your saturated fats intake to less than 7% of calories. Your diet should include oily fish at least twice a week as a source for omega-3 fatty acids.

Make sure you do not take hormone replacement therapy, selective estrogen receptor modulators, antioxidant supplements (vitamin E, C and beta-carotene) and folic acid for primary or secondary prevention of heart disease.

If you are 65 or older, ask your GP for routine low dose aspirin regardless of heart disease risk status. The upper dose of aspirin for high-risk women is 325 mg per day rather than 162 mg.

Reduce bad LDL cholesterol to less than 70 mg/dL in case you have a very high-risk of heart disease.

On New Year’s Day, the Prime Minister gave an interview to ANI, wherein he touched upon various matters of interest to the country. But, a subject that was glaringly missing in his 90 minute conversation was that of Health.

The questions dealt more with current political issues, which will invariably crop up in the coming parliamentary election and the answers seemed to be aimed at reassuring the electorate.

The Prime Minister talked about political violence and also strongly condemned it.

It would have been indeed heartening to further know his views also on violence against doctors and how his government plans to tackle the escalating incidents of violence against doctors across the country.

He also spoke about “economic health” but not “health”, despite several prevailing health issues in the country.

Pollution has become a major public health problem and there seems to be no respite from it. Evidence has documented an association between air pollution and many acute health events such as heart attack, stroke, acute asthma and chronic diseases such as cancer, heart disease, lung diseases (asthma, COPD). But neither harm prevention nor harm reduction due to pollution was addressed by the PM.

There is a wide gap in the availability of healthcare service in the country. On one hand, India is fast becoming the hub of medial tourism, but in a sharp contrast, healthcare including essential healthcare is still out of reach for many people.

India is far from attaining universal health coverage, which is affordable, accessible, available, appropriate and accountable. This is because the public expenditure on health is very less.

Currently, India spends just 1% of its gross domestic product (GDP) on health. Without spending at least 5-6% of the GDP on health, the basic healthcare needs of the population cannot be fulfilled. Although the National Health Policy 2017 has provided for increasing public expenditure on health to 2.5% of GDP from the current ~1% by 2025, it is still very inadequate to provide universal healthcare.

The budgetary allocation of Rs 52,800 crore for health in 2018/19 was merely 5% higher than the revised estimate of Rs 50,079.6 crore, in 2017/18 (Business Today, Feb 19, 2018).

Also, very few people in the country have health insurance coverage. At more than 60%, India has one of the highest out of expenditures on health globally. Poverty arising out of exorbitant health expenses further contributes to the widening inequity in health services. Ayushman Bharat scheme was launched last year as an answer to reduce this gap. We hope that it will be implemented across the country.

India faces a twin burden of diseases: Communicable diseases (endemic + emerging and re-emerging) and non-communicable diseases (NCDs). Diseases that are endemic in the country rear up every year.

The Gorakhpur tragedy last year, where several children lost their lives due to acute encephalitis syndrome (AES) had stirred a debate in the country. But this was not the first AES outbreak in this area. Many such outbreaks have been occurring for several years now and each epidemic has taken a heavy toll of lives.

Similarly, flaring up of Dengue and Chikungunya is an annual feature now. Last year, outbreaks of Nipah virus and Zika virus – both emerging infectious diseases – were reported from Kerala and Rajasthan, respectively. They are now here to stay.

The huge population in the country, lack of education and awareness as well as global travel leave us vulnerable to many such outbreaks. We need to be in a state of constant alert and preparedness to prevent an epidemic in advance instead of responding once an epidemic has occurred. We need to find answers to such continuing epidemics.

Doctors should have been involved in the efforts to address the health issues; but, their autonomy has been dissolved.

Doctors across the country see more than 2 crores of patients every day. Hence, they represent the collective consciousness of people, so they should be part of the solutions for the prevailing health problems and concerns in the country.

India continues to bear the highest burden of tuberculosis (TB) cases globally, including MDR-TB. Many of India’s citizens continue to grapple with lack of adequate sanitation and safe drinking water.

The Prime Minister spoke about Ayushman Bharat as his “biggest achievement”. But, aside from this it was disheartening to note that health appears to be a low priority issue for the government as well as ANI.

If in a 90-minute interview, health could not be a part of the agenda, it’s a sorry state of affairs. Apparently, health will not feature in the manifesto of the upcoming elections.

If India aspires to be a global superpower and become one of the largest economies in the world, health of her citizens needs to be improved. Healthy citizens can contribute much more to the growth of a nation.

We hope the Prime Minister will take up these issues in his next “Mann ki Baat” and allay these concerns.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)

New Delhi, 21st December 2018: Exercise might be as effective as blood pressure medications in lowering systolic blood pressure below 140 mm Hg, indicates a recent study. An exercise regimen could reduce the need for blood pressure lowering medications in the future. he systolic blood pressure is the pressure exerted by the heart while pumping blood out of the heart by contraction of the heart muscles. It represents the top value in a blood pressure reading.

Hypertension is defined as a repeatedly elevated blood pressure exceeding 140/90 mmHg. It is emerging as one of the major lifestyle disorders today. As per estimates, about one-third of the Indian population will suffer from the condition by 2020. Current studies put the prevalence of hypertension at 20% to 40% in urban areas and 12% to 17% in rural areas.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “The prevalence of hypertension in Indian adults has shown a drastic increase in the past three decades in urban as well as rural areas. It is important to get an annual checkup done after the age of 30 even if you have no family history of hypertension, are not diabetic or don’t have any other lifestyle-related disorder. For those in the high-risk category, a checkup is advised every month. Hypertension can be prevented provided a person makes necessary lifestyle changes right at the outset. It is also imperative to spread the message of prevention and encourage people across various age groups to check their blood pressure at regular intervals.”

Some signs and symptoms of hypertension include dizziness, shortness of breath, headaches, fatigue, and sometimes chest pain, palpitations, and nosebleeds.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “High blood pressure imposes an up-front burden in people who know they have it and who are working to control it. It adds to worries about health. It alters what you eat and how active you are, since a low-sodium diet and exercise are important ways to help keep blood pressure in check. Some people need medication and may need to take one or more pills a day, which can be a costly hassle.”

Some tips from HCFI.

• Achieve and maintain a healthy weight for your height

• Exercise regularly

• Eat a diet that is rich in fruits, vegetables, and whole grains

• Limit sodium intake to under 2,300 milligrams a day (one teaspoon of salt) and get plenty of potassium (at least 4,700 mg per day) from fruits and vegetables

• Drink alcohol in moderation, if at all

• Reduce stress

• Monitor your blood pressure regularly, and work with your doctor to keep it in a healthy range